Patient reports about health care experiences are increasingly used to assess selected aspects of health care quality. In this study of more than 12 000 parents of children hospitalized in 1 of 39 hospitals, perceptions of health care quality were related to health status of the child. Parents of children with worse health status rated the quality of care as poorer, compared with parents of children with better health status. Surprisingly, ratings of health care quality were lower for children without than for children with chronic illnesses. The areas in which health care quality was rated lowest were in communication with the child and parent-physician partnership.

In this randomized trial of 52 pediatricians in 12 practices, the effect of a collaborative consultation service promoting the use of titration trials and periodic monitoring during medication maintenance was evaluated. The intervention markedly increased the use of titration trials but did not affect the frequency of regular, systematic monitoring of medication. Those children who received a titration trial had the largest reduction in symptoms, which was partly related to receiving a higher dosage of medication. Children whose parents refused to participate in a titration trial were less likely to be taking medication at 12 months. This model holds promise to improve the health care and health status of children with chronic illnesses.

National Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder

In this national sample of 3082 children, 8.7% met criteria for attention-deficit/hyperactivity disorder (ADHD), half of whom had the inattentive type. Children in the lowest income group were twice as likely to have ADHD as those in the highest income group and were 3-fold more likely to have the hyperactive-inattentive type. Only about half of the children who met criteria for ADHD had received that diagnosis from a physician in the prior year, and only one-third of these children had consistent medication use. Poorer children used the least medication. These findings suggest that diagnosis and treatment of ADHD, especially in poor children, must be improved.

This study surveyed 6522 adolescents aged 10 to 14 years at baseline during a period of 2 years to determine smoking patterns. Smoking was present in 74% of the most popular movies adolescents watched, including 25% of G-rated and 44% of PG-rated movies. In those who were exposed to the most movies with smoking, the risk of becoming established smokers during the 2-year follow-up was increased 2-fold. This effect was 12 times greater in teenagers who were rated as low on sensation seeking compared with teenagers who were high on sensation seeking. This study provides strong support for public health programs that aim to reduce adolescent exposure to movie smoking through voluntary changes in how movies are rated.